This patent is directed to an apparatus and method for determining when a chest tube should be removed, and in particular to an apparatus and method for determining when a chest tube should be removed combinable with a chest tube drainage system.
Each year, over 380,000 lung resections and other events require a chest tube that drains air, and potentially fluids, leaking from the cut surface of the lung into the pleural space. All patients following chest surgery will have at least one chest tube, with some patients having more than one chest tube. The chest tube is attached to a drainage system in which the fluids exiting the chest tube are collected in a collection chamber. The drainage system is in turn attached to suction, to draw fluids and gases out of the pleural space into the drainage system.
At some point, the chest tube should be removed. The chest tube exits between the rib spaces and may impinge the intercostal nerves. This causes discomfort and requires intravenous pain medications. However, if the chest tube is removed too early, the removal of the chest tube can lead to lung collapse and cause major complications.
Air leaks are the largest determinant for leaving chest tubes in patients following cardiothoracic lung procedures. Typically, the decision to remove the chest tube is based on a crude visual inspection (VI) of the drainage system to determine if there is a leak into the plural space. If the visual inspection suggests that a leak exists, then the chest tube is left in place.
While a visual inspection may very well lead to the detection of a leak originating from the cut surface of the lung, the “detected” leak may also be the result of residual intrapleural air, a leak into the pleural space from the outside (e.g., through the chest tube incision around the chest tube), or reverse airflow in the chest tube. It is typically unclear from a simple visual inspection what the source of the “leak” might be. Further, the visual inspection technique may be influenced by patient effort, tube position and presence of fluid or clots in the chest tube, for example.
As mentioned above, if the chest tube is removed based on a visual inspection that is incorrect (e.g., the inspection suggests that there is no leak, or a detected leak is attributed to a cause other than the cut surface of the lung), the removal of the chest tube could lead to lung collapse, requiring replacement of the chest tube. Replacement of the chest tube could lead to complications. In any event, lung collapse and chest tube replacement will increase the length of the hospital stay.
Considering the potential downside of a premature determination of the absence of a leak, healthcare professionals may elect to leave the chest tube in even though there is no actual leak (e.g., the detected leak is attributable to the presence of residual intrapleural air). Of course, this also will increase the length of hospital stay, and leaving the chest tube in when not indicated could also lead to complications.
The costs of a prolonged hospital stay are considerable. Each additional day that a patient spends hospitalized on the thoracic surgery floor is approximately 6500 dollars, although that amount can vary. Moreover, prolonged hospitalization can lead to complications from deep vein thrombosis, pneumonia, hospital acquired infections, etc.
As set forth in more detail below, the present disclosure sets forth a method and an analyzer for use with a chest tube drainage system, as well as the entire system so defined, embodying advantageous alternatives to the existing visual inspection methods.